The adaptive nature of implementation practice: Case study of a school-based nutrition education intervention

ObjectiveTo describe how and why nutritionists implement and strategize particular program operations across school contexts.DesignInstrumental case study with empirical propositions from Actor-Network Theory (ANT). Data derived from interviews with interventionists and observations of their practices.SettingSeven primary schools from disadvantaged Montreal neighborhoods.ParticipantsSix nutritionists implementing the nutrition intervention in grades 4 and 5. From 133 nutrition workshops held in 2005/06, 31 workshops were observed with audio-recordings.Intervention(s)Little Cooks – Parental Networks aims to promote healthy eating behaviors through engagement in food preparation and promotion of nutrition knowledge.Phenomenon of interestThe program-context interface where interventionists’ practices form interactively within a given social context.AnalysisCoding inspired by ANT. Interview analysis involved construction of collective implementation strategies. Observations and audio-recordings were used to qualify and quantify nutritionists’ practices against variations in implementation.ResultsNutritionists privileged intervention strategies according to particularities of the setting. Some such variation was accounted for by school-level social conditions, individual preferences and nutritionists’ past experiences.Conclusions and implicationsImplementation practices are strategic and aim to engage educational actors to achieve intervention goals. These results challenge implementation frameworks centered on purely technical considerations that exclude the social and interpretive nature of practice.

► Implementation practice is strategic in that it aims to engage actors from the ‘user’ system with the goals of the program.
► Strategies used during implementation practice aim to build relationships by considering how program goals respond to needs of ‘user’ system.
► Implementation practice evolves interactively with the particularities of the ‘user’ system and thus adapts over time and between settings.
► Implementation practice identifies the social and technical components to build a ‘new’ network with consolidated goals and operations.
► Implementation practice is a strategic operation to integrate two potentially complementary systems.